Shefali Luthra, Kaiser Health News
President Donald Trump introduced final month that the GOP will change into “the party of health care,” and information experiences counsel he intends to make it a prime concern in his reelection marketing campaign.
So when Mick Mulvaney, the appearing White House chief of workers, touted the administration’s work on prescription drug costs — a hot-button concern that has drawn scrutiny from throughout the political spectrum, and one which voters say ought to be a prime precedence — we had been intrigued.
On “Fox News Sunday” April 7, Mulvaney said: “Drug prices in this country actually came down last year for the first time in 50 years. That’s because Donald Trump’s president.”
This assertion is especially laborious to show affirmatively. Drug costs are measured by a number of metrics and affected by all types of political and financial forces.
We reached out to the White House for extra rationalization. Its workers directed us to a report published last October by its Council of Economic Advisers, in addition to to knowledge suggesting the buyer value index for prescribed drugs declined in January 2019 in contrast with January 2018.
But consultants who reviewed that knowledge stated it doesn’t essentially assist Mulvaney’s declare — and positively not by the magnitude he suggests.
A Broad Brush, And Some Missing Data
We interviewed 5 consultants who all agreed that, regardless of which metric was used, proof is missing to unequivocally say drug costs decreased final yr. The most beneficiant studying got here from Matthew Fiedler, a well being economist on the Brookings Institution: It’s “within spitting distance of something that’s true.”
But with extra examination, the declare’s veracity grew to become murkier.
“Drug prices” can check with many issues: a listing value, a internet value (what’s paid after rebates, or the reductions negotiated by insurers or different payers), the pharmacy’s value or whole nationwide spending on prescribed drugs.
Let’s begin with the latter. Data from the Kaiser Family Foundation reveals whole spending on prescription drug costs has climbed throughout the previous a number of years. (KHN is an editorially impartial program of the muse.) In 2018, whole spending continued to develop, simply at a slower tempo. That’s a optimistic development, consultants famous, nevertheless it isn’t the identical factor as spending taking place.
“It doesn’t mean we’re spending less money on drugs than before,” stated Stacie Dusetzina, an affiliate professor of well being coverage at Vanderbilt University.
We additionally examined the CPI knowledge the White House offered. It might counsel that previously yr prescribed drugs’ record costs have certainly dropped, and even by a significant quantity.
But the CPI knowledge doesn’t account for whether or not producers reducing their record costs have additionally modified the scale of the rebates they supply. That’s important data in understanding if the actual value of a drug — what insurance coverage pays and, finally, what customers pay — has really modified.
These development strains additionally differ relying on the 12-month interval they cowl, argued Walid Gellad, an affiliate well being coverage professor on the University of Pittsburgh. January to January might present a listing value lower, however July to July might present a rise.
Plus, the CPI knowledge consists of solely medication offered by retail, or about three-fourths of all prescriptions. That excludes many high-priced specialty meds offered solely by way of mail order, argued Michael Rea, who heads Rx Savings Solutions, a consulting agency.
It additionally paints with a broad brush — obscuring, many stated, simply what number of record costs are persevering with to climb.
This yr, the record value of greater than three,000 medication went up, whereas the value of solely 117 went down, in response to knowledge compiled by Rx Savings Solutions. Last yr, an analysis by the Associated Press revealed that, from January to July, four,412 branded drug costs went up, whereas 46 had been lower.
So, Mulvaney’s downward value declare didn’t come out of skinny air. But deciphering the info to imply that drug costs are down ignores essential components of the prescription drug market.
The White House’s Work
Mulvaney additionally stated Trump has performed a key function in bringing down drug costs. When we requested the administration what he meant, a spokesman pointed to their efforts to convey extra generic medication to market — a lift the White House stated has fueled competitors and helped make lower-price options accessible to customers.
But there’s no proof but to counsel that the increase in generic drug approvals has that impact. Experts stated it takes time for these merchandise to succeed in , create competitors and exhibit a measurable influence on costs.
Indeed, a lot of these generics, whereas authorised, by no means went to market. This White House assertion additionally doesn’t account for high-priced, branded medication that lack a generic counterpart.
Yes, Trump’s powerful speak — accusing pharma corporations of “getting away with murder” — might have persuaded some drug producers to carry off on rising their costs — not less than quickly, or till after the federal government releases key stats on what number of costs have gone up, Dusetzina stated. But it’s laborious to separate that phenomenon from the stress additionally levied by Congress and state legislatures.
For what it’s price, the administration has proposed many new insurance policies meant to curb drug costs, many famous, reminiscent of eliminating some kinds of rebates, or changing how Medicare Part B pays for medication. But none of these have taken impact — in order that they haven’t introduced costs down.
Mulvaney stated, “Drug prices in this country actually came down last year for the first time in 50 years. That’s because Donald Trump’s president.”
At first look, CPI knowledge might conceivably assist the argument that the record costs for some prescribed drugs dipped. But that knowledge doesn’t embrace many high-priced specialty medication that drive prices up, and the sample it illustrates can change primarily based on the timeframe chosen.
The CPI knowledge set obscures the person medication for which the record costs have elevated — with much more going up than down. It additionally doesn’t account for a drug’s true “net price.”
Mulvaney’s assertion additionally doesn’t replicate traits exhibiting that, nationally, spending on medication has continued to climb, even when that development has slowed. There can be no proof to assist the argument that Trump himself is chargeable for modifications in drug pricing.
This declare has a component of fact, nevertheless it ignores key details and context that may give a really completely different impression. We fee this declare Mostly False.
Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially impartial program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.